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[Factors associated with hyperhomocysteinemia in Crohn's disease]
F Maire1, L Beaugerie, M Cohen
1Service d'Hépato-Gastroentérologie, Hôpital Rothschild, Paris, France. laurent.beaugerie@rth.ap-hop-paris.fr
Insights
Over half of Crohn's disease patients exhibit hyperhomocysteinemia, a risk factor for thrombosis. Addressing modifiable factors like smoking and cobalamin deficiency is crucial for reducing thrombotic risk in these patients.
Area of Science:
- Gastroenterology
- Hematology
- Metabolic Disorders
Context:
- Inflammatory bowel disease (IBD), specifically Crohn's disease (CD), is linked to an increased incidence of thromboembolic events.
- Hyperhomocysteinemia, elevated homocysteine levels, is a recognized risk factor for thrombosis.
- Understanding the prevalence and associated factors of hyperhomocysteinemia in CD is vital for risk stratification and management.
Purpose:
- To determine the prevalence of hyperhomocysteinemia in a cohort of patients with Crohn's disease.
- To identify clinical and biological factors associated with hyperhomocysteinemia in this patient group.
Summary:
- A study of 171 Crohn's disease patients revealed a 52% prevalence of hyperhomocysteinemia (mean homocysteine 14.8 µmol/L).
- Hyperhomocysteinemia was significantly associated with older age, male sex, smoking, lower serum cobalamin, and prior ileal resection.
- Multivariate analysis identified male sex and smoking as independent predictors of hyperhomocysteinemia.
Impact:
- The high prevalence of hyperhomocysteinemia in Crohn's disease underscores the need for proactive screening and management.
- Targeting modifiable risk factors such as smoking cessation and vitamin B12 (cobalamin) repletion can potentially mitigate thrombotic risk in CD patients.
- These findings contribute to a better understanding of the pathophysiology linking Crohn's disease, hyperhomocysteinemia, and thrombosis.
Aims:
The incidence of thromboembolic disease is increased in patients with inflammatory bowel disease. Hyperhomocysteinemia is one of the risk factors for thrombosis. The aims were: 1) to assess the prevalence of hyperhomocysteinemia in a large series of patients with Crohn's disease; 2) to search for clinical and biological factors associated with hyperhomocysteinemia.
Patients And Methods:
One hundred seventy-one patients with Crohn's disease (64 males, 107 females), median age 31 years (range: 16-82), were studied. The median duration of the disease was 7 years. The concentrations of homocysteine, folate, cobalamin and C-reactive protein were measured in serum from blood sample of each patient.
Results:
The mean concentration of seric homocysteine was 14.8 micromol/L (N: 4.4 - 12.4 micromol/L). Hyperhomocysteinemia was observed in 89 patients (52%). It was significantly associated with age, sex, smoking habit, serum cobalamin level and history of ileal surgical resection (P<0.05). In the group of operated patients, there was a statistically significant association between hyperhomocysteinemia and the length of small bowel resected. In multivariate analysis, sex and smoking were associated with hyperhomocysteinemia.
Conclusion:
More than half of the patients with Crohn's disease have hyperhomocysteinemia. This result stresses the need for preventing reversible factors associated with hyperhomocysteinemia, such as smoking and cobalamin deficiency, in order to lower the thrombotic risk of patients with Crohn's disease.